Individual
DR. PERRY HERMAN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
325 COUNTY ROAD 144B, MARBLE FALLS, TX 78654-8020
(830) 798-8314
Mailing address
325 COUNTY ROAD 144B, MARBLE FALLS, TX 78654-8020
(830) 798-8314
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0567
TX
213EP0504X
Public Medicine Podiatrist
0567
TX
213EP1101X
Primary Podiatric Medicine Podiatrist
0567
TX
213ES0000X
Sports Medicine Podiatrist
0567
TX
213ES0131X
Foot Surgery Podiatrist
0567
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008138-01
—
TX
01
—
00AM35
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/31/2006
Last updated
11/30/2014
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